Title: Impact of neighborhood and individual socioeconomic status on survival after breast cancer varies by race/ethnicity: the Neighborhood and Breast Cancer Study.
Authors: Shariff-Marco, Salma; Yang, Juan; John, Esther M; Sangaramoorthy, Meera; Hertz, Andrew; Koo, Jocelyn; Nelson, David O; Schupp, Clayton W; Shema, Sarah J; Cockburn, Myles; Satariano, William A; Yen, Irene H; Ponce, Ninez A; Winkleby, Marilyn; Keegan, Theresa H M; Gomez, Scarlett L
Published In Cancer Epidemiol Biomarkers Prev, (2014 May)
Abstract: BACKGROUND: Research is limited on the independent and joint effects of individual- and neighborhood-level socioeconomic status (SES) on breast cancer survival across different racial/ethnic groups. METHODS: We studied individual-level SES, measured by self-reported education, and a composite neighborhood SES (nSES) measure in females (1,068 non-Hispanic whites, 1,670 Hispanics, 993 African-Americans, and 674 Asian-Americans), ages 18 to 79 years and diagnosed 1995 to 2008, in the San Francisco Bay Area. We evaluated all-cause and breast cancer-specific survival using stage-stratified Cox proportional hazards models with cluster adjustment for census block groups. RESULTS: In models adjusting for education and nSES, lower nSES was associated with worse all-cause survival among African-Americans (P trend = 0.03), Hispanics (P trend = 0.01), and Asian-Americans (P trend = 0.01). Education was not associated with all-cause survival. For breast cancer-specific survival, lower nSES was associated with poorer survival only among Asian-Americans (P trend = 0.01). When nSES and education were jointly considered, women with low education and low nSES had 1.4 to 2.7 times worse all-cause survival than women with high education and high nSES across all races/ethnicities. Among African-Americans and Asian-Americans, women with high education and low nSES had 1.6 to 1.9 times worse survival, respectively. For breast cancer-specific survival, joint associations were found only among Asian-Americans with worse survival for those with low nSES regardless of education. CONCLUSIONS: Both neighborhood and individual SES are associated with survival after breast cancer diagnosis, but these relationships vary by race/ethnicity. IMPACT: A better understanding of the relative contributions and interactions of SES with other factors will inform targeted interventions toward reducing long-standing disparities in breast cancer survival.
PubMed ID: 24618999
MeSH Terms: Adolescent; Adult; Aged; Breast Neoplasms/economics; Breast Neoplasms/ethnology*; Breast Neoplasms/mortality*; Breast Neoplasms/pathology; Carcinoma, Ductal, Breast/ethnology; Carcinoma, Ductal, Breast/mortality; Carcinoma, Ductal, Breast/pathology; Carcinoma, Lobular/ethnology; Carcinoma, Lobular/mortality; Carcinoma, Lobular/pathology; Continental Population Groups/statistics & numerical data*; Ethnic Groups/statistics & numerical data*; Female; Follow-Up Studies; Humans; Middle Aged; Neoplasm Grading; Neoplasm Staging; Prognosis; San Francisco; Social Class*; Socioeconomic Factors; Survival Rate; Young Adult